Provider Demographics
NPI:1366676744
Name:MANTENA, RAKESH (DDS)
Entity type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:MANTENA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MCADOO DR
Mailing Address - Street 2:APT # 426
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7514
Mailing Address - Country:US
Mailing Address - Phone:916-718-0005
Mailing Address - Fax:
Practice Address - Street 1:250 MCADOO DR
Practice Address - Street 2:APT # 426
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7514
Practice Address - Country:US
Practice Address - Phone:916-718-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice